title: Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison.
abstract: OBJECTIVE
  To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care.
  
  
  BACKGROUND
  Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample.
  
  
  METHODS
  We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses.
  
  
  RESULTS
  In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back pain (38% vs 46%).
  
  
  CONCLUSIONS
  Results of this study have implications for the delivery of post-deployment health services to Iraq and Afghanistan War Veterans. Migraine and other headache diagnoses are common among Veterans, particularly women, and tend to occur in combination with other post-deployment health conditions for which patients are being treated.
authors.affiliation: Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center (R&D 66), Portland, OR; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Carlson
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.forename: Emily M
authors.initials: EM
authors.lastname: Hagel
authors.forename: Andrea
authors.initials: A
authors.lastname: Cutting
authors.forename: Robert
authors.initials: R
authors.lastname: Kerns
authors.forename: Nina A
authors.initials: NA
authors.lastname: Sayer
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D015331:Cohort Studies; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D012727:Sex Characteristics; D014481:United States; D014493:United States Department of Veterans Affairs / Q000639:trends; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Veteran; headache; health service use; women